WIDESPREAD DISSEMINATION OF METAL DEBRIS FROM IMPLANTS

In a post-mortem study, we compared subjects with metal implants with and without visible wear with an age-matched control group to determin e the extent and effects of dissemination of wear debris. In subjects with stainless-steel and cobalt-chrome prostheses metal was found in l ocal and distant lymph nodes, bone marrow, liver and spleen. The level s were highest in subjects with loose, worn joint prostheses and the m ain source of the debris was the matt coating. Metal levels were also raised in subjects with implants without visible wear and, to a less e xtent, in those with dynamic hip screws. Necrosis of lymph nodes was s een in those cases with the most wear, and potential damage to more di stant organs such as the bone marrow, liver and spleen in the long ter m cannot be discounted. The consequences for the immune system and the role of metal dissemination in the possible induction of neoplasia ar e discussed.